1. Monday, June 23, 2008Slide 1 KSU Females prospective on Maternity Services in PHC Maternity Services in Primary Health Care Centers : The Females Perception Supervised by: Dr. Saad Al-Ghanim Presented by: Nada A Al-Subki

2. Monday, June 23, 2008Slide 2 KSU Females prospective on Maternity Services in PHC Presentation Outline I. Introduction II. Methodology III. Results IV. Conclusion and Recommendations

3. Monday, June 23, 2008Slide 3 KSU Females prospective on Maternity Services in PHC Introduction Maternal health care is one of the major functions of primary health care centers in Saudi Arabia. It is highly linked to the preventive and curative services of mothers and their well-being babies. Care of mothers is an important issue in the community health care.

4. Monday, June 23, 2008Slide 4 KSU Females prospective on Maternity Services in PHC Objective of the study The study was designed to achieve the following main objectives:: To determine the female perspectives about the maternity services in PHC centers. To determine the major factors affecting the utilization of maternity health services in Riyadh PHC centers.

5. Monday, June 23, 2008Slide 5 KSU Females prospective on Maternity Services in PHC Study Questions In connection with the objectives of the study, this study tries to answer the following main questions: What is the perception of females about maternal health services provided in PHC centers? What are the factors associated with maternal services utilization? How maternal services be improved?

6. Monday, June 23, 2008Slide 6 KSU Females prospective on Maternity Services in PHC Significance of the Study Health care of mothers is one of the main principles of PHC services. Mother’s care constitutes a first step in the care of the community. Mother’s care ensures a good quality of the whole family in the society.

7. Monday, June 23, 2008Slide 7 KSU Females prospective on Maternity Services in PHC METHODOLOGY

8. Monday, June 23, 2008Slide 8 KSU Females prospective on Maternity Services in PHC Research Design This study applies both descriptive and analytical research design.

9. Monday, June 23, 2008Slide 9 KSU Females prospective on Maternity Services in PHC Research Variables (model) Patient-Doctor Relationship variables Satisfaction-related variables Presence of medical services variables Female perception about maternity services in PHC Out Come (Dependent Variables) Aspects (independent variables)

10. Monday, June 23, 2008Slide 10 KSU Females prospective on Maternity Services in PHC Research Population and Sample Selection The study was carried out to target all patient women’s attending the maternal care in primary health care centers in Riyadh city in 2008.

11. Monday, June 23, 2008Slide 11 KSU Females prospective on Maternity Services in PHC Research Population and Sample Selection For this study, 5 PHC were selected randomly in different parts of Riyadh City. 400 Questionnaires were distributed in these PHC and the returned questionnaires comprised 384. This gives a response rate of 96%.

12. Monday, June 23, 2008Slide 12 KSU Females prospective on Maternity Services in PHC Data Collection Method Self-administered questionnaire was used to collect data. The questionnaire consists of two parts: Part one asked questions about the socio- demographic characteristics. Part two asked about items related to the utilization of maternity care: Patient-doctor relationship. Satisfaction-related aspects during maternal visits. Presence of medical services to maternal care.

13. Monday, June 23, 2008Slide 13 KSU Females prospective on Maternity Services in PHC Coding of the perception part: The responses were coded on a 5-point liker scale 1 = Strongly Disagree. 2 = Disagree. 3 = Neither Agree nor Disagree. 4 = Agree. 5 = Strongly Agree.

14. Monday, June 23, 2008Slide 14 KSU Females prospective on Maternity Services in PHC Validity of The Questionnaire The items forming the questionnaire were developed after : reviewing the relevant literature Reviewed by two academic faculty members

15. Monday, June 23, 2008Slide 15 KSU Females prospective on Maternity Services in PHC Reliability of The Questionnaire The Reliability of the questions (related to the perception of mothers ) in the questionnaire was assessed using Cronbach's alpha and was found 0.69 which is accepted in the social research.

16. Monday, June 23, 2008Slide 16 KSU Females prospective on Maternity Services in PHC Method of Data Analysis For the purpose of this study, the following data analyses were used: Descriptive Statistics. Inferential Statistics. The data processed through Statistical Package of Social Sciences (SPSS).

17. Monday, June 23, 2008Slide 17 KSU Females prospective on Maternity Services in PHC RESULTS Results of Descriptive Statistics Results of Inferential Statistics

18. Monday, June 23, 2008Slide 18 KSU Females prospective on Maternity Services in PHC Descriptive Statistics The Descriptive analysis includes: frequency distribution percentages obtained. means and; standard deviation.

19. Monday, June 23, 2008Slide 19 KSU Females prospective on Maternity Services in PHC Socio-Demographic Characteristics of the Respondents VariablesCategoriesFreq. Perc. % Age 30 years or less22458.3 Older than 3016041.7 Nationality Saudi34088.5 Non-Saudi4411.5 Working Yes18247.4 No20252.6 Education level High school22560.2 Higher than high school14939.8 Income 3000 or less15343.1 More than 300020256.9 No. of children 3 or less21857.1 More than 316442.9

20. Monday, June 23, 2008Slide 20 KSU Females prospective on Maternity Services in PHC Health Related Aspects of the Respondents VariablesCategoriesFreq. Perc. % Number of Deliveries 3 or less19457.2 more than 314542.8 Number of Cesareans none26184.7 one or more4715.3 Health Status poor215.5 good36394.5

21. Monday, June 23, 2008Slide 21 KSU Females prospective on Maternity Services in PHC Patient-Doctor Relationship Ranked According to Higher Mean Scores Aspect Disagree (%) Neither Agree Nor Disagree (%) Agree (%) MeanSD my doctor is kind to me every time I see her 0.54.794.84.050.42 I have routine examination in each visit 15.293.84.040.45 my doctor refers me to hospital when need 3.15.291.74.010.55 I communicate with my doctor easily 26.35.568.23.520.99 my complaints are taken into consideration 25.811.2633.471.02 l see my doctor regularly29.97633.431.03 Note: strongly disagree and disagree were combined, and strongly agree and agree were combined.

22. Monday, June 23, 2008Slide 22 KSU Females prospective on Maternity Services in PHC Satisfaction - Related Aspects During Maternal Visits Aspect Disagree (%) Neither Agree Nor Disagree (%) Agree (%) MeanSD I am satisfied with the other health team staff 1.37.890.93.980.48 I am satisfied with the time I spend with my doctor 7.66.386.23.880.68 I am satisfied with the cleanliness of the health center 6.88.684.63.810.71 I am satisfied with wating areas 123.984.13.800.76 I am satisfied with the location of the PHC center 14.63.182.33.780.85 I am satisfied with the waiting time to see my doctor 14.1778.93.760.86 I am satisfied with the appointment time 13.84.481.83.740.86

23. Monday, June 23, 2008Slide 23 KSU Females prospective on Maternity Services in PHC Presence of Medical Services Aspect Disagree (%) Neither Agree Nor Disagree (%) Agree (%) MeanSD the primary health center has qualified female doctors 5.54.290.43.960.63 the medication is available when needed 1.86.891.43.940.42 lab investigations can be made in the center 5.23.691.13.920.56 I am referred to hospitals when needed easily 9.96.383.93.840.74 I receive health education when I attend the PHC center 10.48.381.33.780.83 the ultrasound is available when needed 10.410.978.63.730.73 the female waiting area is comfortable 47.47.345.33.061.11

24. Monday, June 23, 2008Slide 24 KSU Females prospective on Maternity Services in PHC Inferential Statistics For the purpose of this study T-test was used to determine differences among selected variables. ( ONLY significant differences were reported)

25. Monday, June 23, 2008Slide 25 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Age AspectAgeMeanT-testSign I have routine examination in each visit 30 years or less 4 -2.1190.035 older than 30 years 4.09 I am satisfied with the time I spend with my doctor 30 years or less 3.79 -3.3850.001 older than 30 years 4.01 I am satisfied with the other health team staff 30 years or less 3.93 -2.489 0.013 older than 30 years 4.05 I am satisfied with waiting area 30 years or less 3.72 -2.5920.01 older than 30 years 3.92 I am satisfied with the waiting time to see my doctor 30 years or less 3.66 -2.81 0.005 older than 30 years 3.91 I am satisfied with the cleanliness of the PHC 30 years or less 3.89 2.4030.017 older than 30 years 3.7 (only for significant variables)

26. Monday, June 23, 2008Slide 26 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Age AspectAgeMeanT-TestSign I am satisfied with the appointment time 30 years or less 3.84 2.6900.008 older than 30 years 3.59 the female waiting area is comfortable 30 years or less 3.17 2.2730.024 older than 30 years 2.91 lab investigations can be made in the PHC 30 years or less 3.99 2.630 0.009 older than 30 years 3.83 the PHC has qualified female doctors 30 years or less 3.89 -2.5030.013 older than 30 years 4.06 (only for significant variables)

27. Monday, June 23, 2008Slide 27 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Number of Cesareans AspectNo of CesareansMeanT-testSign my doctor is kind to me every time I see her None 4.06 2.1470.033 one or more 3.91 I have routine examination in each visit None 4.05 3.0920.002 one or more 3.83 I communicate with my doctor easily None 3.57 2.620 0.009 one or more 3.17 I am satisfied with the other health team staff None 4.01 2.2480.025 one or more 3.83 I am satisfied with the location of the PHC None 3.69 -3.729 0 one or more 4.04 I am referred to hospital when needed easily None 3.80 -2.3210.022 one or more 3.98 (only for significant variables)

28. Monday, June 23, 2008Slide 28 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Health Status AspectHealth StatusMeanT-testSign my doctor is kind to me every time I see her poor4.33 2.0500.053 good4.04 I communicate with my doctor easily poor4.14 3.9550.001 good3.48 I see my doctor regularly poor4.19 5.1180 good3.38 my complaints are taken into consideration poor4.05 3.3060.003 good3.44 I am satisfied with time I spend with my doctor poor4.33 3.1530.002 good3.86 (only for significant variables)

29. Monday, June 23, 2008Slide 29 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Health Status AspectHealth StatusMeanT-testSign I am satisfied with witting areas poor3.33 -2.4560.023 good3.83 the female waiting area is comfortable poor3.81 3.2440.001 good3.01 the ultrasound is available when needed poor2.9 -5.5320 good3.77 the medication is available when needed poor3.38 -2.9180.008 good3.97 (only for significant variables)

30. Monday, June 23, 2008Slide 30 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Nationality AspectNationalityMeanT-testSign I have routine examination in each visit Saudi4.062.7310.007 Non-Saudi3.86 I see my doctor regularly Saudi3.482.640.009 Non-Saudi3.05 my complaints are taken into consideration Saudi3.543.330.001 Non-Saudi3 I am satisfied with time I spend with my doctor Saudi3.91 Non-Saudi3.682.0120.049 I am satisfied with the other health team staff Saudi42.4090.016 Non-Saudi3.82 I am satisfied with the location of the PHC Saudi3.75 Non-Saudi4-3.7310 lab investigations can be made in the PHC Saudi3.96 Non-Saudi3.662.4660.017 (only for significant variables)

31. Monday, June 23, 2008Slide 31 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Number of Children AspectNationalityMeanT-testSign I am satisfied with the time I spend with my doctor 3 or less 3.8 -2.9570.003 more than 3 4 I am satisfied with the other health team staff 3 or less 3.94 -2.070.039 more than 3 4.04 I am satisfied with waitinig area 3 or less 3.65 -4.9120 more than 3 4.01 I am satisfied with the cleanliness of the PHC 3 or less 3.89 2.5790.01 more than 3 3.7 I am satisfied with the appointment time 3 or less 3.89 4.1050 more than 3 3.52 lab investigations can be made in the PHC 3 or less 3.84 -3.4120.001 more than 3 4.03 (only for significant variables)

32. Monday, June 23, 2008Slide 32 KSU Females prospective on Maternity Services in PHC Differences in Perception According to Number of Deliveries AspectNO. of DeliveriesMeanT-testSign I am satisfied with the time I spend with my doctor 3 or less 3.81 -2.8170.005 more than 3 4.01 I am satisfied with waiting area 3 or less 3.67 -3.9770.00 more than 3 3.98 I am satisfied with the cleanliness of the PHC 3 or less 3.89 2.0080.046 more than 3 3.72 I am satisfied with the appointment time 3 or less 3.87 3.6010.00 more than 3 3.52 lab investigations can be made in the PHC 3 or less 3.87 -3.3650.001 more than 3 4.06 (only for significant variables)

33. Monday, June 23, 2008Slide 33 KSU Females prospective on Maternity Services in PHC CONCLUSION & RECOMMENDATIONS

34. Monday, June 23, 2008Slide 34 KSU Females prospective on Maternity Services in PHC Conclusion The study warrants attention to the importance of the perspectives of female users of the maternity services provided in PHC centers.

35. Monday, June 23, 2008Slide 35 KSU Females prospective on Maternity Services in PHC Conclusion Understanding the factors reported by mothers should be taken into consideration when delivering health care at primary health care centers. The utilization of health services provided for mothers should be acknowledge by both administrators and authority in health care organizations.

36. Monday, June 23, 2008Slide 36 KSU Females prospective on Maternity Services in PHC Recommendations The results emerged form this study highlight some important recommendations: Satisfaction of mothers is important for the acceptance of maternity care.

37. Monday, June 23, 2008Slide 37 KSU Females prospective on Maternity Services in PHC Recommendations Doctor-patient relationship and relationship between mothers and other health staff should be enhanced by more Communication. This can only be done by initiatives from the health care providers in PHC. Services and facilities necessary for maternal care should always be present in the PHC centers.

38. Monday, June 23, 2008Slide 38 KSU Females prospective on Maternity Services in PHC Limitation The study did not cover all PHC centers in Riyadh city. Therefore, the results can not be generalized. Further research should increase the number of PHC centers in the study samples. Another limitation of this study is related to the methodology employed. Probably using different methodology will elaborate on this important research.

39. Monday, June 23, 2008Slide 39 KSU Females prospective on Maternity Services in PHC Limitation Another limitation of this study is that the questionnaire was used to collect data. Further research should use either interviews or focus groups with female users. A combination of more than one data collection tool recommended.

40. Monday, June 23, 2008Slide 40 KSU Females prospective on Maternity Services in PHC THANK YOU!